A heart attack can feel exactly like a pulled muscle, indigestion, or other non-cardiac issues. This confusion is common because the body’s nervous system is sometimes inaccurate in reporting the source of internal pain. Recognizing that a cardiac event may not present with the dramatic, crushing chest pain often shown in movies is the first step toward getting appropriate help.
Why the Symptoms Overlap
A heart attack can mimic a pulled muscle due to referred pain. The nerves carrying signals from the heart share pathways in the spinal cord with nerves coming from the chest wall, shoulder, jaw, and arm.
When the heart muscle is deprived of oxygen during a heart attack, the brain interprets the resulting pain signal as originating from one of these more common, muscular sources. This neurological misinterpretation can cause the discomfort to be felt as a strain in the chest, a sore arm, or even pain in the upper back. The body’s pain mapping system is simply not detailed enough to distinguish between the internal organ and the nearby musculoskeletal structures.
Differentiating Cardiac vs. Musculoskeletal Pain
The most practical clues for differentiation focus on how the pain responds to movement or touch. Musculoskeletal pain, such as from a strained pectoral muscle or costochondritis, is often localized and reproducible. Pressing on the area or changing posture, like stretching or taking a deep breath, will typically increase or decrease the intensity of the discomfort.
In contrast, pain originating from the heart is generally constant and diffuse; it does not change with movement, breathing, or palpation. The quality of the discomfort is also telling. A muscle strain is usually described as sharp, aching, or sore, while cardiac pain is more frequently reported as pressure, tightness, squeezing, or a heavy weight on the chest.
Musculoskeletal pain usually follows a clear physical activity, like lifting weights, and may resolve after a short period of rest. Heart-related pain, such as angina or a heart attack, may begin suddenly or build over minutes and usually lasts for more than a few minutes without subsiding completely. If the pain lingers and is unaffected by rest, it requires further investigation.
Recognizing Other Heart Attack Warning Signs
Because pain alone can be misleading, recognizing accompanying systemic symptoms is important for confirming a possible cardiac event. These secondary signs often occur alongside or overshadow chest discomfort and are particularly prevalent in women, older adults, and those with diabetes. These symptoms occur because the heart’s reduced pumping ability affects other organ systems.
Warning signs include:
- Unexplained cold sweating.
- A sudden onset of nausea or vomiting.
- Lightheadedness or dizziness.
- Shortness of breath, especially if it occurs without exertion.
- Pain that radiates to the jaw, neck, or back, particularly the upper back.
These accompanying symptoms must be acknowledged because some heart attacks, often called “silent” attacks, may have only mild or no chest pain at all. In these cases, severe or unusual fatigue, discomfort in the neck or arm, or flu-like symptoms might be the only indication that something serious is happening. The presence of any systemic signs, even without severe chest pain, necessitates immediate attention.
When to Seek Emergency Help
If you experience chest discomfort that lasts for more than a few minutes, or if it goes away and returns, seek emergency medical care immediately. This is especially true if the discomfort is accompanied by systemic warning signs, such as cold sweat, shortness of breath, or nausea.
Do not attempt to drive yourself to the hospital; instead, call 911 or your local emergency number. Emergency medical services personnel can begin life-saving treatment on the way, which improves outcomes. Medical professionals prefer to rule out a heart attack rather than risk a dangerous delay in treatment, so any doubt should trigger an immediate emergency call.